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High cortisol & high testosterone?
I am a 35yo male and have been suffering form severe depression, no energy, and low libido so I had some testing done.  I submitted a saliva neuro adrenal test by Genova labs and all my major neurotransmitters were way low and the cortisol levels are as follows...9:30am=5.2 ( range 7.0-10), 2:30pm=8.3 (range 3.0-6.0), 7:30pm=13.8 (range 2.0-4.0), 12:30am=8.1 (range <1.5).  So my cortisol is spiking at 7:30pm, and way high at midnight, which is completely backwards.  My DHEA was 285.2 (range 63-644), and testosterone was high at 954!  The test has me puzzled because it should be low if my cortisol is high, correct?  I was on narcotic pain medicine for a sever knee injury for 5 years and when I detoxed from the pain meds I have had all the symptoms stated.  Any help is much appreciated!  Thanks in advance.
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657231 tn?1453836403
Cushing's normally suppresses T but... alas there are exceptions to every rule.

I was one of them myself. I had elevated cortisol and high T (as a female).

One set of tests is not diagnostic, so you have to find a decent doctor to do more testing - 24 hour urine testing, 8 am blood, lots of ancillary labs including ACTH (which is a fussy test), and try to nail it down.

Your one set shows a loss of diurnal rhythm, but most docs will not accept that lab. You have to test to find the source (pituitary, adrenal, or other) and then determine treatment. Surgery or one of the new meds. As a male you have the option of the medication but the high T may be a complication to that as the meds raise estrogen and T and E are related - so... it could be quite unpleasant.
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I can only comment on one matter and that is that testosterone levels and libido are not related. Your testosterone level may be normal, or in your case high, while your libido is low.

In my case my testosterone was normal yet I had low libido.

A low libido can be related to several non testosterone causes, including depression (whih you mention), other medication, anxiety issues, erectile dysfunction etc.

If I were you I would (in the following order):

1. Follow rumpled's advice, she knows a heck of a lot regarding AI
2. Find a neuro-endocrinologist
3. While waiting to see (2) above you could see a men's sexual health physician to rule in or out erectile dysfnuction and recheck your testosterone or a psychologist to work through your depression issues.
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Rumpled, I can't remember if I replied to you but thanks for the help.  So my doctor ordered a 12:00 am saliva test x3 but neither the lab nor the hospital had the supplies.  So I just asked for a referral, waiting to hear from the doc.  have an appt with a pituitary specialist.  Is this the right detection?  There website talks about cushings and all the treatments ect.  Seattle pituitary center.  My first appt is a phone consult.  Am I going in the right direction?  Thanks for the advice, I'm pretty frightened....
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657231 tn?1453836403
The labs are ... I cannot tell you how lab error and the techs held back my diagnosis for YEARS... so yeah I totally believe they did not have the supplies or know the test. They will also completely bung up the ACTH test as well - it needs to be in a chilled tube AND be spun immediately AND after the spin processed to the finally tube for prompt freezing as it degrades in minutes.  You get a low result just from lab handling.

Yes, you need a pit center. The depression is a symptom of the T and cortisol - so I would seek out help, but the meds may interfere with testing, so you need someone that knows pituitary and that the issue is PHYSICAL not mental and help you work things out.

Just do your best to stay on top of things - copies of everything and read up so you know if you have a good endo or an endodud and need to move on.
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